CORRESPONDENCE An Outbreak of Mumps The epidemiology of mumps in India and Meningoencephalitis in Sangli District the magnitude of the problem are not fully appreciated(2). Outbreaks occur at interval of 5-10yrs(2). Mumps continue to occur in epidemic Our institute receives patients from in and proportions despite the availability of an effective around Sangli district. We report sharp rise of vaccine. Finland became the first documented incidence of mumps meningoencephalitis at our country to be free of indigenous mumps and rubella institute during December 2005 to January 2006. with the use of national 2 dose trivalent MMR Total of 10 cases of mumps meningoencephalitis vaccination program, free of charge and on a were admitted. The earliest case was seen in the first voluntary basis, which was launched in 1982(3). We week of December and last case was seen in the 3rd are reporting this case study because, though 9 out of week of January. The age group involved was 3-13 10 of our patients were vaccinated with MMR yrs. (mean being 6.65). It included 9 boys and 1 girl vaccine they developed serious complication of clearly showing male predominance(1). All the mumps like meningoencephalitis. 10 patients were vaccinated according to the The national program does not use MMR, but National Immunization Schedule and 9 patients only measles vaccine. The IAP has recommended were additionally vaccinated with MMR vaccine at inclusion of MMR vaccine in the immunization 15-18 months. Information regarding vaccine strain, schedule(4). batch no. could not be obtained as the patients were vaccinated at different places. The clinical features Funding: This study was being partially funded by Shri included fever greater than or equal to 39ºC (90%), Tatyasaheb Ghatage Charitable Trust, Sangli. vomiting (90%), headache (70%), unilateral Competing interests: None stated. parotitis (50%), bilateral parotitis (50%), S.T. Ghatage, maculopapular rash (20%), generalized tonic-clonic Girish M. Kakade, convulsions (10%). The investigations included Ghatage Pediatric Hospital & PG Institute, raised serum amylase (30%), USG abdomen 230, 4D, Madhavnagar Road, showing hepatomegaly (30%), fissural enhancement Sangli 416 416, on CT scan (20%). There was no case below 1yr; Maharashtra, India. 4 cases between 1 to 5 yrs; 5 cases between 6-10 yrs; E-mail: [email protected] and one case between 11 to 14 yrs. Initial CSF examination showed lymphocytic predominance REFERENCES with cell count range between (per cubic mm): 70- 1. A Koskinjmi M, Rautonen J, Lehtokoski-Lehtiniemi 100 in 1 case, 100-150 in 2 cases, 150-200 in 2 cases, E, Vahri A Epidemiology of encephalitis in 200-300 in 2 cases, 300-500 in 1 case and 500-700 in children: a 20 year suvey Ann. Neural 1991; 29: 3 cases, mean being 314.2. Subsequent CSF 492-497. examination showed a progressive decrease in the 2. John TH. An outbreak of mumps in Thiru- total cell count. Initial protein ranged between 28 to vananthapuram district. Indian Pediatr 2004; 41: 180 mg% (mean being 66.1 mg% with range 28-49 298-300. mg% – 4 no.of cases, 50-99 mg% – 4 no. of 3. Mumps and rubella elimination from Finland. cases,100-200 mg% – 2 no. of cases). Initial sugar JAMA 2000; 284: 2643-2647. ranged between 40-93 mg% (mean being 59.2 mg%) 4. Committee on immunization, Indian Academy of with CSF / blood glucose ratio being 0.64%. There Pediatrics update on immunization policies, was no death. The patients are being followed up and guidelines and recommendations. Indian Pediatrics did not develop any neurological deficit till date. 2004; 41: 239-244. INDIAN PEDIATRICS 235 VOLUME 44__MARCH 17, 2007.